Little is know about the costs incurred and quality of care provided persons dying in nursing homes (NHs). Research available on management of pain in NHs suggests unmanaged pain is prevalent. Hospitalization research reveals that NH care at the end of life is fragmented and fraught with avoidable hazards and that the costs of hospitalization are substantial. Preliminary work suggests that hospice care in the NH positively influences pain management, hospitalization rates, and terminal care costs. Needed is additional, more sophisticated research to derive the most statistically valid comparisons of the differences effected by hospice care in NHs. We propose to used linked Medicare, Medicaid, and NH resident assessment data drawn from Florida, supplemented with similar data from 7 other states, to address descriptive and analytic study aims taking into consideration the influence of patient, organizational and market factors as determinants of cost and quality of care experiences of terminally ill NH residents.
Study aims are: 1) To describe Medicare and Medicaid costs for NH decedents in the last year of life and the relative distribution of these costs by category (e.g., hospice, hospitalization, Medicaid per diem, other) and by short versus long NH stays, patient diagnosis (cancer, dementia, and other) and hospice election; 2) To examine the impact of Medicare hospice enrollment on hospitalization at the end of life adjusting for patient, organizational, and market factors; 3) To examine the effect of hospice on Medicare and Medicaid costs incurred by NH residents adjusting for patient, organizational and market factors and using a dual approach; a) A retrospective examination of costs of hospice and non-hospice care among NH decedents; and b) A prospective examination of costs for NH residents identified via a propensity score as having a terminal prognosis of 6 months or less; and 4) Examine the effect of hospice on the intensity and frequency of pain at the end of life adjusting for patient, organizational and market factors. The proposed study will provide policymakers with information vital for informed decisions on how best to preserve budget integrity while improving end of life care in NHs.
| Intrator, Orna; Hiris, Jeffrey; Berg, Katherine et al. (2011) The residential history file: studying nursing home residents' long-term care histories(*). Health Serv Res 46:120-37 |
| Gozalo, Pedro L; Miller, Susan C; Intrator, Orna et al. (2008) Hospice effect on government expenditures among nursing home residents. Health Serv Res 43:134-53 |
| Miller, Susan C; Mor, Vince N T (2002) The role of hospice care in the nursing home setting. J Palliat Med 5:271-7 |
| Miller, S C; Gozalo, P; Mor, V (2001) Hospice enrollment and hospitalization of dying nursing home patients. Am J Med 111:38-44 |
